Call it an unhealthy chain reaction: A pandemic sweeps the world, causing turmoil for everyone — not just those who get sick — worsening depression and anxiety, which puts people at higher risk for heart disease.
It’s a trend researchers have documented and presented last weekend at the American Heart Association’s Scientific Sessions.
The harmful effects may reverberate for years to come, said Heidi May, the principal investigator of the study who researches the link between cardiovascular disease and depression.
“COVID has affected all of us in so many different ways and it’s been stressful for a lot of people because it’s so been so disruptive to their normal life. Then there’s the stress of worrying about, ‘Am I sick? Is my family sick if? If I do have COVID, am I going to be OK?’” May, an epidemiologist at Intermountain Heart Institute in Salt Lake City, Utah, told TODAY.
“It’s only natural when you have big life changes to have some changes in your mental health.”
May and her colleagues noticed some of those changes at Intermountain Healthcare’s primary care clinic. More than one-third of patients, 38%, reported becoming depressed or experiencing continued symptoms of depression during the first year of the pandemic.
The findings are based on 4,633 patients who filled out a depression screening questionnaire in the year before the coronavirus crisis and during its initial 12 months (March 2020 to April 2021).
Since depression and anxiety are associated with an increased risk of cardiovascular disease, that may translate into another long-term effect of the pandemic — more heart disease cases even in people who never had COVID at all, May noted.
“Our emotional lives have profound consequences for the biomechanical pump,” Dr. Sandeep Jauhar, director of the Heart Failure Program at Long Island Jewish Medical Center, told TODAY.
The link between depression and heart disease
The relationship has been studied for decades and seems to be a two-way street. Adults with depression have a 64% greater risk of developing coronary artery disease, while depressed coronary artery disease patients are 59% more likely to suffer a heart attack or cardiac death, according to the National Heart, Lung and Blood Institute.
“Some might say, ‘Well, which one comes first? Is it depression or the heart disease?’ Because if you find out you have heart disease, of course you’re going to be depressed,” May said.
“But there have been studies that have shown patients with depression then go on to have cardiovascular disease.”
Perhaps it’s because factors associated with depression — whether physiological, such as an increase in stress hormones and inflammation; or behavioral, such as less activity and a poor diet — are also risk factors for heart disease.
“Depression and depressive symptoms are not just in the brain,” Dr. Christopher Celano, associate director of the Cardiac Psychiatry Research Program at Massachusetts General Hospital, told the American Heart Association.
“Your brain is connected to every other part of your body… things that happen in your body can affect how you think and feel. And changes in your brain can affect many different parts of your body, including your heart.”
Depression associated with increased ER visits for anxiety
In the new analysis, depressed patients visited the emergency room at 3.5 times greater rate for anxiety compared to their non-depressed peers. When it came to anxiety with chest pain, the hospital visit rate was 2.7 times greater among the depressed.
Symptoms that might prompt people to seek emergency care for anxiety include a racing heart, a panic attack or feeling extremely nervous — like they can’t calm down, May noted.
Anxiety attacks can also be mistaken for a heart attack, she added, since a person’s chest might tighten, leading to pain or shortness of breath.
The fact that people were avoiding hospitals and emergency rooms during the early months of the pandemic but some still went anyway to get help for their anxiety suggests their symptoms were probably “on the more severe side,” May said.
It highlights the importance of discussing mental health during wellness visits with primary care doctors to help patients with depression early and reduce their risk of future heart problems, the study concluded.
“It’s going to be really important to be aware of if someone is depressed — let’s make sure we treat them just like we would any other risk factor,” May said.
“We make sure we’re physically active. Well, we need to make sure we’re taking care of ourselves mentally as well.”